Tales from the Emergency Department; in which a man who wallows in nostalgia, and secretly wishes he were a Victorian KnifeMan rants about his work and what passes for a life.
He's heard it might be therapeutic...
Names have been changed to protect the innocent.
Any resemblence to parties alive or dead is purely coincidental

Sunday, September 16, 2007

I spend a lot of time commuting. This not only costs me a lot in petrol, but gives me too much time to think. I often compose long witty posts on the way home... then give up, and go to bed. Or I rant - lately my beloved bore the brunt of this nonsense, but no more. So for better, or worse, I'm ranting at you this morning.

It's always a bad idea. Especially if you're as histrionic as I am - what seems to have assumed the import of the treaty of Versailles right now, will be as nothing tomorrow. But I've got a bee in my bonnet tonight. Moaning about colleagues is bad juju. There but for the grace a dieugo I, and so on.

However...

Big hospital's protocols are REALLY pissing me off right now. I accept that protocols are valuable, so everyone gets the same, best treatment available. Part of me will never be convinced that they act to cover up poor training, but there you go. What fucks me off the most tho, is that they engender a blinkered attitude. Daring to go off protocol is heresy.

Tonight, when I dared to question the accepted drug dose protocol for one of the analgaesics we use in kids, there was a flat refusal to entertain my questions. It must be said that this is, undoubtedly, in part because of the manner of my questioning.

I'm not very diplomatic.

Even so, I was always taught to ask if I didn't understand something...

In pointing out what appeared to be a misprint, wherein one part of the protocol contradicted another, the answer was: 'we don't care what you say. This is protocol. It must be right'.

This sort of blind faith / refusal to consider alternatives seems the very anathema of good medicine to me. The answer to the question 'Why?' cannot simply be: 'Because'. Can it? Aren't we supposed to think?

I become equally, if not more, frustrated when colleagues decline to discuss there treatment plans.

Again, my method of 'discussion' surely doesn't help.

Example:I recently answered the phone (always a mistake in the ED). On the other end was the father of a young patient, wanting to know where the details of his daughter's echocardiogram were. She had been seen 2 days earlier, and "the doctor" had told them she needed an echo. But no details had reached her GP.

I told him I'd investigate, and fax the necessary paperwork to the GP.

Having dug out the notes, I was plodding through the Department, when on of the specialist cardiac nurses stopped me, having recognised her writing on the clerking. I explained the situation, finishing with my, unkind, opinion that the patient's complaint was likely to be of a non-organic nature.

'Oh, no' my colleague assured me; 'she had a leaky heart valve when she was 5'

I ventured that I didn't think this was likely to be the cause of her chest pain.

'But she was terribly breathless' came the reply.

Somewhat over-zealously, I suggested that if the concern was that this young girl had a 'leaky valve' that so impaired her cardiac function, surely discharging her from hospital, with no treatment, wasn't in her best interest.

Again, perhaps slightly rabidly, I suggested that if this were the case, surely the best management plan would not be to send her home, untreated.

Why, I trumpeted, if you were so concerned about all these terrible pathologies, did the patient get discharged, with no treatment, and no follow up?

My less than polite manner had it's usual effect... 'Well if you're going to be like that, I'm not going to help. It's your problem.'

Indeed; MY problem. Trying to sort out a patient I had never seen, who had been variously 'diagnosed' as having heart failure secondary to valvular pathology, or a PE, but sent away with no treatment, and the idea that an echocardiogram might be of use, ("non-urgently"), BY THE CARDIOLOGY SERVICE. (Who, in case you haven't been following, were now telling me it was my problem...)

It doesn't make sense to me, to defend your diagnosis, when you didn't take it seriously enough to arrange the necessary admission, investigation and follow up. In fact it seems indefensible.

("Oh, yes, I'm sure he had a leaking aneurysm; so I sent him home...")

Rant over. I'm not quite bilious to have lost all insight, so I hope I have conveyed the petty, small minded nature of my grumbles. When I get on my high horse, I fair see me own arse. I still think I'm right, mind, but I guess I could be a bit cleverer in trying to convince everyone else of this fact...

On the plus side, we treated a fella with multiple rib fracture tonight. Everyone got on, I wasn't rude to anyone, nor did I disagree with the way I as allowed to treat him, and he and his wife were very pleased with the way they were treated

Saturday, September 15, 2007

I've taken the Queen's Shilling - again. And at what cost? A return to solitude.

My beloved and I have gone our separate ways; can I philosophise about it here? I'm not sure; she might read it, and I don't know how fair that is. Suffice to say, I failed in my duty as 'significant other'. Much as I wanted to, I couldn't give enough of myself to do her justice. I am become a self-fulfilling prophecy, afraid to commit, because I fear the end, but bringing about the very thing I dread most.

For right or wrong, I have allowed my work to dominate who I am. It's difficult to feel good about that a lot of the time, especially when you wake up lonely and alone at two in the morning...

Sunday, September 02, 2007

I'm not sure about this one. Clearly there are some things that no-one else needs to know about; maybe I need to write it. You don't need to read it tho'...

Action in the resus room, usually fills me with an unhealthy glee. Achance for action! for derring-do! heroics! (or flailing, of which more after this god-awful set of nights...)

But it paints the most dreadful pictures too.

When the call came for a patient found down, and not seen for 10 days, all the 'joy' went out of the room; at first we thought it might be a prank. I know that doesn't sound funny, but the ED breeds its own variety of humour. Think about it - everything's funny for a certain value of the word 'funny'.

It wasn't a prank.

I've always believed a person would be hard pushed to stay alive much longer than 4 days without water. In the end, this one made it 9, we think. I don't know how they ended up on the floor, but the pressure sores made it clear they hadn't moved much. Deep, leathery, abutting bone; teeth eroding through the top lip. A smell all at once reminiscent of public urinals at the end of a big night, the morgue on a hot day, and something deeper and darker - earthy and ripe. One eye swollen shut, but the other staring helplessly out.

Dear God, let him be unconscious; I'd like to tell myself he was unaware, that all was dark to him.

But I'm afraid that wasn't true. I'll never know, for sure, but in my heart, I'm terrified that he knew. That he felt. What had become of him.

I'm sure there are worse things to behold - in war, in starvation, in poverty... I just haven't seen any of them. I've no idea what this person was like in life; they sure as hell fought hard enough to stay alive... I just don't know if that's enough.

Sometimes we can't even give you your dignity, no matter how hard we want to, how hard we try.

Saturday, September 01, 2007

Everyone has a thing that makes them squirm. Maybe more than one. At work, it's smells. Hospitals have a smell all of their own, and each department smells slightly different. I think I found the Burns Unit the most unsettling - because it has ripe smells, but is warm and humid. The whole effect was... unusual.

A patient came to us the other day, alive, wishing they weren't. In too many pieces.

Three, since you were wondering.

It wasn't what they wanted, I guess. I think they wanted to die. Not this. We had to hide them.

The legs, in bags. The stumps, under a sheet. Enforced denial. Information control.

But it smelled like being in the local butchers, when I was a kid. I couldn't stop the images of a bloody floor, caked in sawdust. Raw meat smells like raw meat, whoever it belonged to... I'm not sure anyone else noticed in all the bustle. And, it's hard to explain to other people.

This morning I can smell blood, sweat and tears; remnants of quiet horror seem to have invaded my nasal passages.

How's that for melodrama? or histrionics? I'm pretty sure there's a word for it...

I've been at Big Hospital for 4 months now. I'm kinda settled in. Always takes me a while, whenever I move. This feels longer than usual. Give it another two? I dunno... I've no choice either way.

Big Hospital is a grand hospital, but I have felt less part of a team, of a family than in previous departments. Sometimes I feel less valued, and less worthwhile. Unfortunately, we both think we're cleverer than we are. I guess I've reached a stage in my training where I feel I can, and should be allowed to do things my way. It's not like that anymore, and I'm sure that's for the best, even if I can't see it sometimes.

I guess the next stage of my development is to learn how to be a team player again. especially as I seem to think I don't have to.

Legal Disclaimer

All the patient details reperesented here are composite. The details of my movements and activities are as accurate as I can make them, but the rest is largely made up. The Shroom's opinions do not represent those of the NHS at large, and should not be taken as a substitute for seeing a proper doctor. Lastly, and for what its worth, all the material herein is copyright The Shroom, and I reserve the right to send large bald men to your place of residence if you reproduce it without permission.